Provider Demographics
NPI:1306207378
Name:BONNIE J FRASER MD PC
Entity type:Organization
Organization Name:BONNIE J FRASER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-576-5880
Mailing Address - Street 1:PO BOX 401357
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-1357
Mailing Address - Country:US
Mailing Address - Phone:702-576-5880
Mailing Address - Fax:702-750-1414
Practice Address - Street 1:8975 W CHARLESTON BLVD STE 130-24
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5470
Practice Address - Country:US
Practice Address - Phone:702-576-5880
Practice Address - Fax:702-750-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty